Idaho Administrative Code
Title IDAPA 16 - Health and Welfare, Department of
Rule 16.03.02 - SKILLED NURSING FACILITIES
Section 16.03.02.200 - NURSING SERVICES
Universal Citation: ID Admin Code 16.03.02.200
Current through August 31, 2023
The following requirements must be met: (3-17-22)
01. Director of Nursing Services (DNS). A licensed registered nurse currently licensed by the state of Idaho and qualified by training and experience is designated DNS in each SNF and is responsible and accountable for the following: (3-17-22)
a. Participating in the development and
implementation of resident care policies; (3-17-22)
b. Developing and/or maintaining goals and
objectives of nursing service, standards of nursing practice, and nursing
policy and procedures manuals; (3-17-22)
c. Assisting in the screening and selection
of prospective residents in terms of their needs, and the services available in
the facility; (3-17-22)
d.
Observing and evaluating the condition of each resident and developing a
written, individualized patient care plan that is based upon an assessment of
the needs of each resident, and that is kept current through review and
revision; (3-17-22)
e. Recommending
to the administrator the numbers and categories of nursing and auxiliary
personnel to be employed and participating in their recruitment, selection,
training, supervision, evaluation, counseling, discipline, and termination when
necessary. Developing written job descriptions for all nursing and auxiliary
personnel; (3-17-22)
f. Planning
and coordinating orientation programs for new nursing and auxiliary personnel,
as well as a formal, coordinated in-service education program for all nursing
personnel; (3-17-22)
g. Preparing
daily work schedule for nursing and auxiliary personnel that includes names of
employees, professional designation, hours worked, and daily patient census;
and (3-17-22)
h. Coordinating the
nursing service with related resident care services;
(3-17-22)
02. Minimum Staffing Requirements. That minimum staffing requirements include the following: (3-17-22)
a. A Director
of Nursing Services (DNS) works full time on the day shift but the shift may be
varied for management purposes. If the DNS is temporarily responsible for
administration of the facility, there is a licensed registered nurse (RN)
assistant to direct patient care. The DNS is required for all facilities five
(5) days per week. (3-17-22)
i. The DNS in
facilities with an average occupancy rate of sixty (60) residents or more has
strictly nursing administrative duties. (3-17-22)
ii. The DNS. in facilities with an average
occupancy rate of fifty-nine (59) residents or less may, in addition to
administrative responsibilities, serve as the supervising nurse.
(3-17-22)
b. A
supervising nurse, licensed registered nurse, or a licensed practical nurse,
and who meets the requirements designated by the Idaho Board of Nursing to
assume responsibilities as a charge nurse and meets the definition in
Subsection 002.35. (3-17-22)
c. A charge nurse, a licensed registered, or
a licensed practical nurse, and who meets the requirements designated by the
Idaho Board of Nursing to assume responsibilities as a charge nurse in
accordance with the definition in Subsection
002.07. A charge nurse is on
duty as follows: (3-17-22)
i. In SNFs with an
average occupancy rate of fifty-nine (59) residents or less a licensed
registered nurse is on duty eight (8) hours of each day and no less than a
licensed practical nurse is on duty for each of the other two (2) shifts.
(3-17-22)
ii. In SNFs with an
average occupancy rate of sixty (60) to eighty-nine (89) residents a licensed
registered nurse is on duty for each a.m. shift (approximately 7:00 a.m. - 3:00
p.m.) and p.m. shift (approximately 3:00 p.m. to 11:00 p.m.) and no less than a
licensed practical nurse on the night shift. (3-17-22)
iii. In SNFs with an average occupancy rate
of ninety (90) or more residents a licensed registered nurse is on duty at all
times. (3-17-22)
iv. In those
facilities authorized to utilize a licensed practical nurse as charge nurse,
the facility must make documented arrangements for a licensed registered nurse
to be on call for these shifts to provide professional nursing support.
(3-17-22)
d. Nursing
hours per resident per day are provided to meet the total needs of the
residents. The minimum staffing is as follows: (3-17-22)
i. Skilled Nursing Facilities with a census
of fifty-nine (59) or less residents provide two and four-tenths (2.4) hours
per resident per day. Hours do not include the DNS but the supervising nurse on
each shift may be counted in the calculations of the two and four-tenths (2.4)
hours per resident per day. (3-17-22)
ii. Skilled Nursing Facilities with a census
of sixty (60) or more residents provide two and four-tenths (2.4) hours per
resident per day. Hours do not include the DNS or supervising nurse.
(3-17-22)
iii. Nursing hours per
resident per day are required seven (7) days a week with provision for relief
personnel. (3-17-22)
iv. Skilled
Nursing Facilities are considered in compliance with the minimum staffing
ratios if, on Monday of each week, the total hours worked by nursing personnel
for the previous seven (7) days equal or exceed the minimum, staffing ratio for
the same period when averaged on a daily basis and the facility has received
prior approval from the Licensing Agency to calculate nursing hours in this
manner. (3-17-22)
e.
Combined Hospital and Skilled Nursing Facility. In a combined facility the DNS
may serve both the hospital and long term care unit with supervising and charge
nurses as required under Subsection
200.02.b. and 200.02.c. In a
combined facility of less than forty-one (41) beds, the supervising or charge
nurse may be an LPN. Combined beds (forty-one (41) or less) represent the total
number of acute care (hospital) and long term care (nursing home) beds.
(3-17-22)
f. Waiver of Licensed
Registered Nurse as Supervising or Charge Nurse. In the event that a facility
is unable to hire licensed registered nursing personnel to meet these
regulation requirements, a licensed practical nurse will satisfy the
requirements so long as: (3-17-22)
i. The
facility continues to seek a licensed registered nurse at a compensation level
at least equal to that prevailing in the community; (3-17-22)
ii. A documented record of efforts to secure
employment of licensed registered nursing personnel is maintained in the
facility; (3-17-22)
iii. The
facility maintains at least forty (40) hours a week R.N. coverage.
(3-17-22)
g. There is at
least two (2) nursing personnel on duty on each shift to ensure resident safety
in the event of accidents, fires, or other disasters. (3-17-22)
h. Nursing care is given only by licensed
staff, nursing personnel, and auxiliary nursing personnel.
(3-17-22)
03. Resident Care. That nursing staff must document on the resident medical record, any assessments of the resident, any interventions taken, effect of interventions, significant changes and observations, and the administration of medications, treatments, and any other services provided, and entries made at the time the action occurs with signature, date and time. At a minimum, a monthly summary of the resident's condition and reactions to care must be written by a licensed nursing staff person. (3-17-22)
04. Medication Administration. Medications must be provided to residents by licensed nursing staff or certified medication assistants (MA-C) per established written procedures that includes at least the following: (4-6-23)
a.
Administered per physician's, dentist's, or nurse practitioner's written
orders; (4-6-23)
b. The resident is
identified prior to administering the medication; (3-17-22)
c. Medications are administered as soon as
possible after preparation; (3-17-22)
d. Medications are administered only if
properly identified; (3-17-22)
e.
Medications are administered by the person preparing the medication for
delivery to the resident (exception: Unit dose); (3-17-22)
f. Residents are observed for reactions to
medications and if a reaction occurs, it is immediately reported to the charge
nurse and attending physician; (3-17-22)
g. Each resident's medication is properly
recorded on their individual medication record by the person administering the
medication. The record includes: (3-17-22)
i.
Method of administration; (3-17-22)
ii. Name and dosage of the medication;
(3-17-22)
iii. Date and time of
administration; (3-17-22)
iv. Site
of injections; (3-17-22)
v. Name or
initial (that has elsewhere been identified) of person administering the
medication; (3-17-22)
vi.
Medications omitted; (3-17-22)
vii.
Medication errors (that are reported to the charge nurse and attending
physician.) (3-17-22)
05. Tuberculosis Control. To assure the control of tuberculosis in the facility, there is a planned, organized program of prevention through written and implemented procedures that are consistent with current accepted practices and includes: (4-6-23)
a. The results of a T.B. skin test is
established for each resident upon admission. If the status is not known upon
admission, a T.B. skin test is done as soon as possible, but no longer than
thirty (30) days after admission. (3-17-22)
b. If the T.B. skin test is negative, the
test does not have to be repeated. (3-17-22)
c. If the T.B. skin test is positive, if
determined upon admission or following the test conducted after admission, the
resident receives a chest x-ray. A chest x-ray conducted thirty (30) days prior
to admission is acceptable. (3-17-22)
d. When a chest x-ray is indicated and the
resident's condition presents a transportation problem to the x-ray machine, a
Sputum culture for m.tuberculosis is acceptable instead of a chest x-ray until
the resident's next visit for any purpose to a place where x-ray is available.
(3-17-22)
e. Annual T.B. skin
testing and/or chest x-rays are not required. (3-17-22)
f. If a case of T.B. is found in the
facility, all residents and employees are retested.
(3-17-22)
Disclaimer: These regulations may not be the most recent version. Idaho may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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